AGREEMENT BETWEEN CLINICAL EXAMINATION AND PARENTAL MORBIDITY HISTORIES FOR CHILDREN IN NEPAL

Parental histories are often used to estimate the prevalence and the i mpact of interventions on child morbidity, but few studies have examin ed the agreement between parental histories and clinical examination. We compared clinical findings with a same-day parental morbidity histo ry for preschool-age children in rural Nepal. A 15 per cent sample of children from 40 wards in Sarlahi district, Nepal, was selected for pa rticipation and 814 same-day morbidity histories were obtained from pa rents, A clinician, masked to the parent's history, visited the househ old 2-4 h later and examined the child for signs of morbidity symptoms about which the parent had previously been questioned. Signs included measurement of temperature, respiratory rate, examination of stools, ear discharge, and presence of persistent cough. Agreement between the history and clinical examination was excellent for ear infection (kap pa = 0.75) and history of measles rash (kappa = 0.74), moderate to poo r for diarrhoea (kappa = 0.21) and fever (kappa = 0.31), and there was no evidence of agreement for dysentery (kappa = -0.01), rapid breathi ng (kappa = 0.06), and cough (kappa = 0.09), The prevalence of dysente ry, fever, cough, and rapid breathing was lower if clinical signs rath er than histories were used. The prevalence of diarrhoea was higher if the presence of a loose stool in a cup rather than a history was used . The prevalence of ear infections and measles was comparable with bot h methods. The agreement between histories and clinical examination va ries by morbidity type, as does the prevalence of morbidity estimated by one or other method.